Infection with COVID-19 is no longer a public emergency: But what about degenerative dementia?

Although no longer considered a public health threat, post-COVID cognitive syndrome continues to impact on a considerable proportion of individuals who were infected with COVID-19. Recent studies have also suggested that COVID may be represent a critical risk factor for the development of Alzheimer's disease (AD). We compared 17 COVID patients with 20 controls and evaluated the effects of COVID-19 on general cognitive performance, hippocampal volume, and connections using structural and seed-based connectivity analysis. We showed that COVID patients exhibited considerably worse cognitive functioning and increased hippocampal connectivity supported by the strong correlation between hippocampal connectivity and cognitive scores. Our findings of higher hippocampal connectivity with no observable hippocampal morphological changes even in mild COVID cases may be represent evidence of a prestructural compensatory mechanism for stimulating additional neuronal resources to combat cognitive dysfunction as recently shown for the prodromal stages of degenerative cognitive disorders. Our findings may be also important in light of recent data showing that other viral infections as well as COVID may constitute a critical risk factor for the development of AD. To our knowledge, this is the first study that investigated network differences in COVID patients, with a particular focus on compensatory hippocampal connectivity.

Topological network mechanisms of clinical response to antidepressant treatment in drug-naive major depressive disorder.

AIM: There is rapidly increasing evidence that remission of MDD is associated with substantial changes in functional brain connectivity. These New data have provided a holistic view on the mechanism of antidepressants on multiple levels that goes beyond their conventional effects on neurotransmitters. METHOD: The study was approved by the Local Ethics Committee of Istanbul Medipol University (10840098-604.01.01-E.65129) and followed the Helsinki Declaration principles. In our study, we have evaluated the effect of six weeks of treatment with antidepressants (escitalopram and duloxetine), and tested the underlying brain functional connectivity through a Graph analysis approach in a well-defined first-episode, drug-naive, and non-comorbid population with MDD. RESULTS: Beyond indicating that there was a significant correlation between the antidepressant response and topological characteristics of the brain, our results suggested that global rather than regional network alterations may be implicated in the antidepressant effect. CONCLUSION: Despite the small-sample size and non-controlled study design, our study provides important and relevant clinical data regarding the underlying mechanisms of the antidepressants on topological dynamics in the human brain.

Relationships among retropalatal airway, pharyngeal length, and craniofacial structures determined by magnetic resonance imaging in patients with obstructive sleep apnea.

BACKGROUND: The integration of anatomical and nonanatomical parameters will improve our ability to predict the outcomes of OSA treatment. Currently, no standardized, quantitative classification of upper airway anatomical traits is available. The retropalatal (RP) airway is the most important area to consider when planning anatomical treatment. However, current evaluation methods feature qualitative conventional endoscopy. Here, we describe a quantitative magnetic resonance imaging (MRI) method used to classify RP airway patterns. METHODS: We recruited 117 males; 20 simple snorers and 97 patients with OSA. Lateral/anteroposterior ratios were calculated in three parallel planes and RP patterns were classified accordingly. Lateral wall soft tissue structures, skeletal dimensions representing those planes, pharyngeal lengths, and skeletal and vertical axis ratios were also measured. RESULTS: Both the cross-sectional area at the hard palate level and the RP lateral dimension were associated with OSA. OSA patients had longer pharynges than controls. The oblique pattern was associated with narrow lateral dimensions. The vertical pattern was associated with a narrow nasopharynx but a longer pharynx. The airway ratio at the hard palate level and the skeletal ratios of all three planes were negatively correlated with the vertical axis ratio and together explained 40.8% of the variance in the vertical axis ratio. CONCLUSIONS: The data suggest that anatomical imbalances between the craniofacial skeletal and soft tissue structures affect pharyngeal airway morphology in all three dimensions. The dimensions of the nasopharynx, the cross-sectional area at the hard palate level, and pharyngeal length were associated not only with the RP patterns but also with OSA severity. This study affords insights into upper airway anatomy and RP patterns and may help diagnose OSA patients and aid in the selection of an appropriate therapy.

High sensitivity C-reactive protein and cerebral white matter hyperintensities on magnetic resonance imaging in migraine patients.

BACKGROUND: Migraine is a common headache disorder that may be associated with vascular disease and cerebral white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI) scan. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that may predict subclinical atherosclerosis. However, the relation between migraine, vascular risks, and WMHs is unknown. We evaluated hs-CRP levels and the relation between hs-CRP level and WMHs in adult migraine patients. METHODS: This case-control study included 432 subjects (216 migraine patients [without aura, 143 patients; with aura, 73 patients]; 216 healthy control subjects without migraine; age range 18-50 y). Migraine diagnosis was determined according to the International Classification of Headache Disorders II diagnostic criteria. The migraine patients and control subjects had no known vascular risk factors, inflammatory disease, or comorbid disease. The presence and number of WMHs on MRI scans were determined, and serum hs-CRP levels were measured by latex-enhanced immunoturbidimetry. RESULTS: Mean hs-CRP level was significantly greater in migraine patients (1.94 ± 2.03 mg/L) than control subjects (0.82 ± 0.58 mg/L; P ≤ .0001). The mean number of WMHs per subject and the presence of WMHs was significantly greater in migraine patients (69 patients [31.9%]; 1.68 ± 3.12 mg/dL) than control subjects (21 subjects [9.7%]; 0.3 ± 1.3; P ≤ .001). However, there was no correlation between hs-CRP level and WMHs in migraine patients (r = 0.024; not significant). The presence of WMHs was increased 4.35-fold in migraine patients (odds ratio 4.35, P ≤ .001). CONCLUSIONS: High hs-CRP level may be a marker of the proinflammatory state in migraine patients. However, the absence of correlation between hs-CRP level and WMHs suggests that hs-CRP is not causally involved in the pathogenesis of WMHs in migraine patients. The WMHs were located mostly in the frontal lobe and subcortical area.

Increased frequency of gallbladder stone and related parameters in hemodialysis patients.

BACKGROUND/AIMS: The prevalence of gallbladder stone (GBS) is shown to be increased in some studies in patients with chronic kidney disease (CKD). Nevertheless, some other studies did not confirm these findings. The controversial results about the prevalence of GBS in hemodialysis (HD) patients demand new studies to search GBS prevalence and associating risk factors in HD patients. In the present study, we aimed to investigate GBS prevalence and risk factors in our HD patients. MATERIALS AND METHODS: A total of 104 HD and 149 control patients were involved. Complete physical examinations, including measurements of dry body weight and height, were done. Abdominal ultrasonography was conducted by the same experienced radiologist. Blood samples were drawn via venipuncture from the study participants after they had fasted overnight just before a midweek hemodialysis session for laboratory examinations. RESULTS: The prevalence of GBS in HD patients was 34.6 % (36/104), and that was significantly higher than that of control group 12.9% (17/149; p=0.0001). In all study participants (HD patients and control group), patients with GBS were older than patients with no GBS (63.2±14.2 vs 53.7±16.7; p=0.0001). However, in HD patients, mean age was similar in patients with GBS and no GBS (64.3±13.8 vs 60.1±16.6; p>0.05). Patients with GBS had a higher prevalence of units of blood transfusions than patients with no GBS in hemodialysis patients (2.0±2.9 vs 0.9±1.3; p=0.047) CONCLUSION: The present study showed an increased prevalence of GBS in HD patients compared to healthy controls. The number of blood transfusions and autonomic neuropathy may be responsible for the increased prevalence of GBS in HD patients.

A rare cause of acute lower abdominal pain: Emphysematous cystitis.

Emphysematous cystitis is a relatively rare infection characterized by the accumulation of air within the urinary bladder wall and bladder lumen. Diabetes mellitus and neurogenic bladder are the major risk factors of emphysematous cystitis. The clinical presentation varies from asymptomatic to fatal disease state. Computed tomography is the best diagnostic imaging modality. Here, we present a case of an 81-year-old woman with poorly controlled type II diabetes mellitus who had acute lower abdominal pain after a percutaneous transluminal coronary angioplasty which demonstrated emphysematous cystitis caused by Escherichia coli that resolved with antibiotic treatment.

The relationship between the prevalance and size of lumbar ossified ligamentum flavum and the presence and degree of facet joint degeneration.

OBJECTIVES: To investigate whether there is any relationship between the prevalence and the dimension of OLF and the presence and degree of facet joint degeneration. In addition, it revealed the prevalence and distribution of lumbar OLF with regard to age and spinal levels. METHODS: The stone protocol abdominal CT images of 114 patients were retrospectively analyzed. Presence of OLF, degenerative changes in the posterior vertebral elements was evaluated on axial CT images and incidence for each finding was determined. Additionally, the degree of facet joint degeneration and size of OLF was evaluated and recorded. All findings were also grouped based on age and lumbar level. RESULTS: OLF has been observed in 40 (35%) individuals at 76 (13%) lumbar levels. OLF has been most frequently encountered at the upper lumbar levels. Its frequency and size showed correlation to increased age. Frequency of OLF correlated with the presence of degenerative changes of in the posterior elements (p<0.001). There was an association between the OLF size and the presence (p=0.001) and degree of the degeneration in the posterior elements. There was no lumbar level case where the degree of OLF would lead to enough narrowing to be symptomatic. CONCLUSIONS: OLF prevalence and sizes increase parallel to age. Posterior elements' degenerative changes facilitate OLF development. A close relation exists between OLF size and facet joint degeneration. A direct relationship exists between OLF size and the degree of posterior elements degeneration. It is highly probable for lumbar level OLF size to be insufficient to cause any symptoms.

Diffusion MRI of acute pancreatitis and comparison with normal individuals using ADC values.

The aim of this study was to retrospectively measure and compare pancreatic apparent diffusion coefficient (ADC) in patients with acute pancreatitis (AP) with aged matched controls who underwent diffusion weighted imaging (DWI). The institutional review board approved this retrospective Health Insurance Portability and Accountability Act compliant study with a waiver for informed consent. Pancreatic ADC values from 27 patients with a clinical diagnosis of AP and 38 normal age-matched controls evaluated with DWI (b = 0 and 800 mm(2)/s) were retrospectively and independently measured by two radiologists. The ADCs were compared between the groups and between each of the pancreatic segments in the normal group. Inter-observer reliability was calculated and receiver operating characteristic analysis was used to determine the sensitivity and specificity of DW imaging in the diagnosis of acute pancreatitis. P < 0.05 was considered statistically significant. The ICC for inter-observer reliability was 0.98 in the control and 0.97 in the AP group. The mean pancreatic ADC in the AP group (1.32 × 10(-3) mm(2)/s ± 0.13) was significantly lower than in the normal group (1.77 × 10(-3) mm(2)/s ± 0.32). There was no significant difference in mean ADCs between each of the pancreatic segments in the controls. A threshold ADC value of 1.62 × 10-3 mm(2)/s yielded a sensitivity of 93% and specificity of 87% for detecting acute pancreatitis for b values of 0 and 800 s/mm(2). Pancreatic ADCs are significantly lower in patients with AP than normal controls.

Diffusion-weighted MR imaging of abdominopelvic abscesses.

This study was conducted to determine the incremental value of diffusion-weighted MR imaging (DW-MRI) over T2-weighted imaging diagnosing abdominopelvic abscesses and compare apparent diffusion coefficient (ADC) values of abscesses and non-infected ascites. In this IRB-approved, HIPAA-compliant study, two radiologists retrospectively compared T2-weighted, T2-weighted + DW-MRI and T2-weighted + contrast enhanced MR images of 58 patients (29 with abscess, 29 with ascites) who underwent abdominal MRI for abscess detection. Confidence and sensitivity was compared using McNemar's test. ADC of abscesses and ascites was compared by t test, and a receiver operating characteristic (ROC) curve was constructed. Detection of abscesses and confidence improved significantly when T2-weighted images were combined with DW-MRI (sensitivity: observer 1-100%, observer 2-96.6%) or contrast enhanced images (sensitivity: both observers-100%) compared to T2-weighted images alone (sensitivity: observer 1-65.5%, observer 2-72.4%). All abscesses showed restricted diffusion. Mean ADC of abscesses (observer 1-1.17 ± 0.42 × 10(-)³ mm²/s, observer 2-1.43 ± 0.48 × 10(-3) mm²/s) was lower than ascites (observer 1-3.57 ± 0.68 × 10(-3) mm²/s, observer 2-3.42 ± 0.67 × 10(-3) mm²/s) (p < 0.01). ROC analysis showed perfect discrimination of abscess from ascites with threshold ADC of 2.0 × 10(-3) mm²/s (Az value 1.0). DW-MRI is a valuable adjunct to T2-weighted images diagnosing abdominopelvic abscesses. ADC measurements may have the potential to differentiate abdominal abscesses from ascites.

Nonneoplastic cystic lesions of pancreas: a practical clinical, histologic, and radiologic approach.

Cystic lesions of pancreas are increasingly identified due to widespread use and improved resolution of cross-sectional imaging. These lesions are broadly classified into neoplastic and nonneoplastic cysts. Nonneoplastic cysts have no malignant potential and include pseudocysts, retention cysts, benign epithelial cysts, abscesses, duodenal wall cysts (diverticula), lymphoepithelial cysts, and the recently described mucinous nonneoplastic cyst. Herein, we report the clinical presentation, histology, and imaging findings of nonneoplastic cystic lesions of the pancreas together with pancreatic necrosis.

Evaluation of the relationship between L5-S1 spondylolysis and isthmic spondylolisthesis and lumbosacral-pelvic morphology by imaging via 2- and 3-dimensional reformatted computed tomography.

PURPOSE: The purpose of this study was to investigate the differences in the axial and coronal parameters of lumbosacropelvic morphology among a population with spondylolysis and healthy individuals by using 2- and 3-dimensional (3D) reformatted computed tomographic images. Moreover, this study aimed to evaluate the differences in sagittal geometry. MATERIALS AND METHODS: The stone protocol abdominal computed tomographic images of 386 patients were retrospectively analyzed. Thirty individuals who had spondylolysis at L5-S1 level were included in the study. Moreover, a control group of individuals free of spondylolysis and spondylolisthesis was formed, similar in age and sex to the study group. A number of linear and angular lumbosacral morphologic parameters were evaluated using 2D and 3D reformatted computed tomographic images. The data of the 2 groups were compared using a t test. RESULTS: There was an association between spondylolysis and decreased interpedicular angle and S1 vertebra interfacet index, increased distance between the iliac crest and L5 vertebral transverse process, decreased L5 pedicle width, and increased height of the iliac crest and decreased L5 vertebra sagittal index. The paravertebral muscle area was larger in the lysis group when compared with the healthy individuals. CONCLUSIONS: Multiple factors (eg, interpedicular angle, S1 vertebra interfacet index, the distance between the iliac crest and L5 vertebra transverse process, L5 pedicle width, height of the iliac crest and L5 vertebra sagittal index) in lumbosacropelvic morphology affect the defect development in pars interarticularis. In individuals with spondylolysis, paravertebral muscle hypertrophy develops as a secondary adaptive change.

MRI for acute neurologic complications in end-stage renal disease patients on hemodialysis.

Acute cerebrovascular disease is one of the most frequent causes of mortality and morbidity in patients on long-term hemodialysis therapy. Early recognition of cerebrovascular events improves the prognosis and quality of life of end-stage renal failure patients. This paper reviews the magnetic resonance imaging features of acute neurological findings in patients with end-stage renal failure.

Dynamic contrast-enhanced MR imaging findings of bone metastasis in patients with prostate cancer.

AIM: To evaluate the dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) findings of bone metastasis in prostate cancer patients. METHODS: Sixteen men with a diagnosis of metastatic prostate cancer to bones were examined with DCE-MRI at 1.5 Tesla. The mean contrast agent concentration vs time curves for bone metastasis and normal bone were calculated and K(trans) and ve values were estimated and compared. RESULTS: An early significant enhancement (wash-out: n = 6, plateau: n = 8 and persistent: n = 2) was detected in all bone metastases (n = 16). Bone metastasis from prostate cancer showed significant enhancement and high K(trans) and ve values compared to normal bone which does not enhance in the elderly population. The mean K(trans) was 0.101/min and 0.0051/min (P < 0.001), the mean ve was 0.141 and 0.0038 (P < 0.001), for bone metastases and normal bone, respectively. CONCLUSION: DCE-MRI and its quantitative perfusion parameters may have a role in improving the detection of skeletal metastasis in prostate cancer patients.

Multiple progressive focal nodular hyperplasia lesions of liver in a patient with hemosiderosis.

Focal nodular hyperplasia (FNH) is the second most common benign lesion of the liver. It is a solitary lesion and usually does not enlarge. We present the magnetic resonance imaging findings of multiple progressive FNH lesions in a patient with hemosiderosis using Gadolinium-EOB-DTPA (Eovist) as a hepatobiliary contrast agent. The possible mechanisms underlying the occurrence and progression of FNH lesions and the potential value of Eovist in characterizing the lesions were discussed.

Polysplenia syndrome accompanied with situs inversus totalis and annular pancreas in an elderly patient.

Polysplenia syndrome (PS) is rarely encountered in elderly. It is characterized by multiple spleens associated with various cardiac and gastrointestinal abnormalities including partial or complete agenesis of dorsal pancreas. Situs inversus totalis (SIT) is a rare congenital anomaly with mirror image of viscera combined with dextrocardia. Occurrence of SIT and PS in the same patient is exceedingly rare. We present the first case of adult PS with SIT accompanied with annular pancreas.

Magnetic resonance imaging in the visualization of benign tumors and tumor-like lesions of hand and wrist.

The differential diagnosis of benign tumors and tumor-like lesions of the hand and wrist region is important with regard to choosing the therapy (medical versus surgical), or to decide to just follow-up the lesion. In most of the cases the proper analysis of MRI findings in correlation with the patient's history is sufficient to meet a specific diagnosis. However, diagnostic confusion is not uncommon as there are numerous lesions affecting the hand and wrist region. This pictorial essay offers a practical radiological approach to benign tumors and tumor-like lesions of the hand and wrist region based on most frequently observed MRI findings.

Doppler ultrasound evaluation of morphological and hemodynamical changes of hepatic and mesenteric structures in end-stage renal disease patients on regular hemodialysis.

PURPOSE: The goal of the present study is to sonographically investigate the effects of hemodialysis on the hepatic and mesenteric circulation in end-stage renal disease (ESRD) patients on a regular-basis hemodialysis and compare with healthy subjects. MATERIALS AND METHODS: Twenty ESRD patients on regular hemodialysis and 20 control subjects were included in the study. Measurements of the diameter, mean velocity, and volume flow of the portal vein (PV), hepatic artery (HA), and superior mesenteric artery (SMA) were obtained in ESRD patients on a regular hemodialysis program (30 min before and after dialysis procedure) and in healthy subjects. FINDINGS: After hemodialysis procedure, increase in the diameters of the HA (P = 0.023), SMA (P = 0.017), and PV (P = 0.04), decrease in the mean flow velocities of the HA (P = 0.0001), SMA (P = 0.0001), and PV (P = 0.001) and decrease in the volume flow of the HA (P = 0.037), SMA (P = 0.013), and PV (P = 0.033) were noticed. On the other hand, comparison of vessel diameters (HA: P = 0.429; SMA: P = 0.968; PV: P = 0.529), mean flow velocities (HA: P = 0.989; SMA: P = 0.149; PV: P = 0.221), and volume flow values (HA: P = 0.82; SMA: P = 0.795; PV: P = 0.512) of the control group and the ESRD patients group before dialysis procedure showed no statistically significant difference. CONCLUSION: Hemodialysis is demonstrated to have acute and important effects on mesenteric and hepatic circulation (increase in diameter and decrease in velocity and volume flow), as on other vascular beds. These hemodynamic and morphologic changes are reversible and easily evaluated using Doppler US.

The relation between sagittal morphology of the lumbosacral spine and the degree of lumbar intervertebral disc degeneration.

OBJECTIVES: We investigated the relationship between the lumbosacral morphology and degree of intervertebral disc degeneration in a large sample of young patients. In addition, the relation between various morphological parameters (sacral table angle and sacral kyphosis) and lumbar disc herniation or degeneration was also evaluated. METHODS: The magnetic resonance imaging (MRI) of low back pain patients referred to our department in 2008-2009 were retrospectively evaluated. Patients with prior lumbar spinal surgery, serious congenital anomalies on MRI, incomplete or complete lumbosacral trancision, severe scoliosis, spondylolysis, or spondylolisthesis were excluded from the study. A sample of 131 females between 20-30 years of age was studied. Patients were evaluated for the presence of intervertebral disc herniation or degeneration, and the degree of degeneration was assessed. Angles of lumbar lordosis, sacral table, and sacral kyphosis were also measured for each patient. RESULTS: The degree of intervertebral disc degeneration increased in parallel to the decrease in the sacral kyphosis and lumbar lordosis angles, and to the increase in sacral table angle. A statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (23.37±7.09°, 163.09±9.48°, 104.34±5.47°, respectively) and without intervertebral disc degeneration (26.94±7.39°, 168.94±10.52°, 100.83±4.32°; p=0.006, p=0.001, p=0.0001, respectively). In addition, a statistically significant difference with regard to the angles of lumbar lordosis, sacral kyphosis, and sacral table was determined between individuals with (22.82±6.94°, 162.23±9.53°, 104.94±5.19°, respectively) and without intervertebral disc herniation (27.25±7.26°, 169.39±9.96°, 100.48±4.33°; p=0.001, p=0.0001, p=0.0001, respectively). CONCLUSION: The degree and risk of intervertebral disc degeneration and herniation increases in parallel to the decrease in sacral kyphosis and lumbar lordosis, and to the increase in sacral surface angle.

Multiple extradural spinal arachnoid cysts causing diffuse myelomalacia of the spinal cord.

INTRODUCTION: Extradural spinal cyst is a rare cause of compression myelopathy. It is usually solitary and its typical location is posterior to the spinal cord. We present a case of multiple spinal arachnoid cysts causing diffuse myelomalacia secondary to a significant compression of the spinal cord with no symptom relief after surgical decompression. CASE REPORT: A 35-year-old female patient presented to our hospital complaining of progressive weakness and numbness of both lower extremities for the last 2 months, being more prominent on the right side. Her history was significant for back pain that started after a vaginal delivery 1 year ago. Spinal MRI revealed multiple extradural arachnoid cysts and diffuse myelomalacia. A T4-T6 level laminectomy was performed. The cyst was nearly totally resected. There was partial symptomatic relief after surgery, but 5 months later her symptoms worsened. MRI revealed nodular syringomyelia and atrophy of the thoracic spinal cord. CONCLUSIONS: Extradural spinal arachnoid cyst is to be considered in the differential diagnosis of spinal cord compression. Vaginal delivery may accelerate the process and symptoms by a sudden increase in the cyst size. In cases of myelomalacia secondary to cyst pressure postoperative results are quite poor.